Declaration Of Contamination - HSR DIF 501 Montageanleitung Und Bedienungsanleitung

DECLARATION OF CONTAMINATION

The repair, service and/or disposal of vacuum equipment and components will only be carried out if a correctly completed declaration has
been submitted. Non-completion will result in delay.
This declaration can only be completed and signed by authorized and qualified staff.
Description of product
Type
Article No.
Serial No.
The product is free of any substances
which are damaging to health
  
H armful substances, gases and/or by-products
Please list all substances, gases and by-products which may have come into contact with the product:
Trade/product name
manufacturer
Legally binding declaration:
I hereby declare that the information supplied on this form is complete and accurate. The dispatch of the contaminated product will
be in accordance with the appropriate regulations covering packaging, transportation and labelling of dangerous substances.
Name of organization or company
Address
Phone
E-Mail
Name
Data and legally binding signature
This form can be downloaded This form can be downloaded
from our website: www.hsr.li
from our website.
54
Reason for return

Operating fluid(s) used

Process related contamination of product:
toxic
corrosive
biological hazard
explosive
radioactive
other harmful substances
yes 
Dangerous
Chemical name
material class Measures if spillage
(or symbol)
Post code, place
Fax
Company stamp
Copies:
Original to manufacturer or representative - 1 copy attach to consignment packaging - 1 copy for file of sender
PDA501-W / PDB501-W
no  yes 
no  yes 
no  yes  *)
no  yes  *)
no  yes  *)
no  yes 
*) Products thus conta-
minated will not be
accepted without
written evidence of
decontamination!
First aid in case of
contact
DIF05deHSR (201605)